HomeMy WebLinkAboutBIRCH AFFIDAVIT - 21-00310 - Birch Properties, LLC - Birch Property - Approx. 301 S 12th W - Rezone to LDR1, LDR2, & LDR3Submit by E-mail
35 North I°' East
Rexburg, ID 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
City of Rexburg
Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3022
I, De-lotres
Name
SU G a v C.1!i J
c
Being first duly sworn upon oath, depose and say:
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Address
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State
(If Applicant is also Owner of Record, skip to B)
CITY O T
REXTiURG
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Annma",Imn,4 Co.mmfy
A. That I am the record owner of thepproperty described on the attached, and I grant my
permission to:i)r,en4-tHolt ie=rSon 3355W,Lea 1 ¢gge.5'o
GdAsharla PincvclL 112 $uu+k aple, Sugarc.i}y =p 8344$
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herein or as to the
ownership of the property which is the subject of the application.
Dated this 3 day of Ian 4,V -C L-,., , 20 A
Signature
Subscribed and sworn to before me the day and year fust above written.
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..08- �'•% Notary Punk of
Residing at:
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oy�n 1°• My commission expires:
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